Stratified management based on surface antibody for the prevention of hepatitis B virus reactivation in lymphoma patients

Summary This study aimed to investigate a stratified approach based on hepatitis B virus (HBV) surface antibody (anti‐HBs) for managing HBV reactivation (HBVr) in lymphoma patients with serological protection against HBV. A retrospective analysis was conducted on 209 lymphoma patients with a baseline anti‐HBs titre of ≥10 iu/L, who were either positive or negative for HBV core antibody (anti‐HBc). The results revealed that 15.7% of patients lost serological protection following 6‐month anti‐lymphoma therapy. With a median follow‐up of 28.1 months, the cumulative rates of HBVr at 6 months, 2 years and 4 years were 2.9%, 4.7% and 6.3% respectively. Without intervention, the overall rate of reactivation was 2.0% for patients with isolated anti‐HBs and 10.5% for those with positive anti‐HBs and anti‐HBc. To identify patients at high risk of losing seroprotection and susceptible to HBVr, a predictive model was developed. The high‐risk group had significantly higher rates of serological protection loss (27.8% vs. 2.2%) and cumulative incidence of HBVr (22.0% vs. 0%) compared to the low‐risk group. Overall, this study highlights the risk of HBVr in lymphoma patients with positive anti‐HBs, with or without positive anti‐HBc, and recommends periodic monitoring for low‐risk patients and early intervention for high‐risk patients.